Pancreatitis imaging

B12. Block, S., Maier, W., Bittner, R., Biichler, M., Malfertheiner, P., and Beger, H. G., Identification of pancreas necrosis in severe acute pancreatitis Imaging procedures versus clinical staging. Gut 27, 1035-1042 (1986). 

To be of value in routine clinical practice, any pancreatic function test is required to be not only precise and reliable, but also uncomplicated and inexpensive. However, due to the peculiarities of pancreatic anatomy and physiology, no currently available test meets all these criteria. Indeed, despite astounding developments in virtually every other diagnostic held (including pancreatic imaging), pancreatic exocrine function is estimated today by using very much the same principles and even methods as three decades ago. 

Pancreas Oral cholecysto-graphic agent iopanoate ( ) experimental Unknown excretion into pancreatic duct Schmiedl U etal (1994) Imaging of exocrine pancreatic function investigation of the bioavailability of weak organic acids as potential pancreatic contrast agents for computed tomography. Invest Radiol 29 689-694... 

Contrast-enhanced computed tomography (CT) is used to identify the cause of pancreatitis and confirm the diagnosis. Magnetic resonance imaging is used to grade the severity of AP and identify bile duct abnormalities not seen on CT. Ultrasonography is useful to determine pancreatic enlargement and peripancreatic fluid collections. 

The sensitivity and specificity of plain film and contrast study in acute pancreatitis are low. Therefore, they are mostly used to demonstrate complications of AP. Percutaneous sonography is usually the imaging method of choice in patients with acute abdominal distress due to its wide availability, but in the case of AP the distended intestine often impairs adequate visualization of the pancreas. Still, sonography may be used as an excellent imaging modality for short-term follow-up studies, particularly in extremely ill patients who are unable to undergo computed tomography (CT). 

Magnetic resonance imaging is comparable to CT in its capacity to diagnose acute pancreatitis and provide precise information regarding the severity of the disease (A4, L9, P10, R12). However, due to the limited availability for emergency diagnosis it has not been widely used for routine clinical practice. 

As new imaging tools have become available, such as CT and MRI, many attempts have been made to evaluate imaging criteria for assessing the severity of acute pancreatitis. The first severity index of acute pancreatitis was developed in 1990 by Balthazar et al. (B2). The CT Scoring Index (CTSI) is a 10-point system based on the degree and the type of changes in pancreatic parenchyma and peripancreatic tissues as well as the extent of pancreatic necrosis. The majority of studies confirm its clinical utility for prediction of severity of AP (K6, LI, M20, S14, VI) however, some authors report CT to be ineffective (L13, L14). 

A4. Amano, Y., Oishi, T., Takahashi, M., and Kumazaki, T., Nonenhanced magnetic resonance imaging of mild acute pancreatitis. Abdom. Imaging 26, 59-63 (2001). 

B22. Biichler, M. W., Correlation of imaging procedures, biochemical parameters and clinical stage in acute pancreatitis. In Diagnostic Procedures in Pancreatic Disease (P. Malfartheiner, ed.), pp. 123. Springer-Verlag, Berlin, 1986. 

P10. Piironen, A., Kivisaari, R., Kemppainen, E., Laippala, P., Koivisto, A. M., Poutanen, V. P., and Kivisaari, L., Detection of severe acute pancreatitis by contrast-enhanced magnetic resonance imaging. Eur. Radiol. 10, 354-361 (2000). 

It is only the ability of modern chemistry to detect very small quantities of materials that made the following discovery possible. In some recent research it was reported that one subtle way in which cancer tumours cells differ from normal cells is how they metabolize carbohydrates present on their surfaces. Cancer cells have far more of the carbohydrate sialic acid, which can be detected with MRI (magnetic resonance imaging) analytical techniques. It was found that the sialic acid normally appears on the surface of the cells only in foetal development, but it appears abnormally in patients with gastric, colon, pancreatic, liver, lung, prostate and breast cancers, as well as in leukaemia. Research is continuing.1... 

Figure 3.8 Histological images of different PanIN grades stained with H E. It is believed that pancreatic intraepithelial neoplasias (PanINs) are the precursor lesions of pancreatic ductal adenocarcinoma (PDAC). PanINs are histologically subdivided into four different grades, namely PanIN-lA/B,...

Gallium-68 68 Ga 68.1 min Study of thrombosis and atherosclerosis, PET imaging, detection of pancreatic cancer, attenuation correction... 

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